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F A Pameijer

Publications and source records attributed to F A Pameijer.

15 recordsLinked to original sources
PubMed2004

The significance of circumscribed malignant mammographic masses in the surveillance of BRCA 1/2 gene mutation carriers.

Breast cancers in gene mutation carriers may escape mammographic detection because of rapid growth and tumor expansion. Therefore, they may mimic benign lesions on the mammogram. Twenty-nine BRCA 1/2 mutation carriers under surveillance developed 31 breast cancers between 1994 and 2001 at a mean age of 44.2 years. Controls were 63 women with 67 breast cancers in the same period at a mean age of 53.8 years, also under surveillance because of a life time risk of at least 15%. In 26% of the carriers vs. 48% of the controls, mammography was the method that first suspected a malignancy. Seven radiologists performed a retrospective review of the original mammograms to establish technical assessment, with special attention for circumscribed lesions and estimated probability of malignancy. In the mutation carriers seven (23%) circumscribed non-calcified mammographic masses were found and three in the controls (4.5%) P=0.01. These masses were proven to be malignant. In both groups around 70% of these fast-growing circumscribed lesions were detected by the patients. The masses were situated in breasts with a good interpretable breast pattern. BRCA 1/2 mutation carriers had a significantly higher percentage of circumscribed non-calcified mammographic masses that proved to be malignant. These mammographic lesions in women at high risk should be described as at least Birads 0 and worked-up with ultrasound and needle biopsy.

Adult↗
PubMed2001

Occult primary tumors of the head and neck: accuracy of thallium 201 single-photon emission computed tomography and computed tomography and/or magnetic resonance imaging.

OBJECTIVE: To determine the accuracy of thallium 201 single-photon emission computed tomography (thallium SPECT) and computed tomography and/or magnetic resonance imaging (CT/MRI) in the detection of occult primary tumors of the head and neck. DESIGN: Study of diagnostic tests. SETTING: National Cancer Institute, Amsterdam, the Netherlands. PATIENTS AND METHODS: Thirty-two patients with a neck node metastasis of an epithelial tumor and negative findings by mirror examination at initial presentation were included in the study. Twenty-nine patients underwent thallium SPECT and CT/MRI before examination under general anesthesia (EUA). In 3 patients only thallium SPECT was performed before EUA. Histological confirmation of an occult primary tumor during EUA was used as the gold standard. Negative radiodiagnostic and nuclear findings in the upper aerodigestive tract in the presence of a primary carcinoma other than of the head and neck were interpreted as true-negative findings. RESULTS: For thallium SPECT the following results were recorded: sensitivity, 67%; specificity, 69%; accuracy, 69%; positive predictive value, 33%; and negative predictive value, 90%. In 1 patient, thallium whole body scan indicated a primary carcinoma beyond the mucosal lining of the upper aerodigestive tract. The CT/MRI results were as follows: sensitivity, 71%; specificity, 73%; accuracy, 72%; positive predictive value, 45%; and negative predictive value, 89%. CONCLUSIONS: Thallium SPECT and CT/MRI showed comparable results for detection of occult primary tumors of the head and neck. A potential advantage of thallium SPECT is that it allows total body screening.

Adult↗
PubMed2000

Laryngeal or hypopharyngeal squamous cell carcinoma: can follow-up CT after definitive radiation therapy be used to detect local failure earlier than clinical examination alone?

PURPOSE: To determine if follow-up computed tomography (CT) after definitive radiation therapy for laryngeal or hypopharyngeal (laryngopharyngeal) carcinoma allows the detection of local failure earlier than clinical examination alone. MATERIALS AND METHODS: Pre- and post-radiation therapy follow-up CT scans in 66 patients were reviewed retrospectively. All patients underwent definitive hyperfractionated radiation therapy and were followed up clinically for at least 2 years after its completion. Post-radiation therapy CT scans (N = 153) were evaluated for posttreatment changes with a three-point score: A score of 1 represented expected posttreatment changes; 2, focal mass with a maximal diameter of less than 1 cm and/or asymmetric obliteration of laryngeal tissue planes; or 3, focal mass with a maximal diameter equal to or greater than 1 cm or estimated tumor volume reduction of less than 50%. All patients underwent the first posttreatment CT study 1-6 months after therapy. New or progressive laryngeal cartilage changes were noted. The clinical impression of the larynx at the time of each follow-up CT scan was also recorded. RESULTS: In 12 of 29 (41%) patients with treatment failure at the primary site, follow-up CT scans were definite for local failure (score, 3) a mean of 5.5 months (median, 3.5 months; range, 1-17 months) before clinical examination results. CONCLUSION: In many patients, follow-up CT shows local failure earlier than does clinical examination alone.

Adult↗
PubMed1999

Pre- and post-radiotherapy computed tomography in laryngeal cancer: imaging-based prediction of local failure.

PURPOSE: To determine if pre-radiotherapy (RT) and/or post-radiotherapy computed tomography (CT) can predict local failure in patients with laryngeal carcinoma treated with definitive RT. METHODS AND MATERIALS: The pre- and post-RT CT examinations of 59 patients (T3 glottic carcinoma [n = 30] and T1-T4 supraglottic carcinoma [n = 29]) were reviewed. For each patient, the first post-RT CT study between 1 and 6 months after irradiation was used. All patients were treated with definitive hyperfractionated twice-daily continuous-course irradiation to a total dose of 6,720-7,920 cGy, and followed-up clinically for at least 2 years after completion of RT. Local control was defined as absence of primary tumor recurrence and a functioning larynx. On the pre-treatment CT study, each tumor was assigned a high-or low-risk profile for local failure after RT. The post-RT CT examinations were evaluated for post-treatment changes using a three-point post-RT CT-score: 1 = expected post-RT changes; 2 = focal mass with a maximal diameter of < 1 cm and/or asymmetric obliteration of laryngeal tissue planes; 3 = focal mass with a maximal diameter of > 1 cm, or < 50% estimated tumor volume reduction. RESULTS: The local control rates at 2 years post-RT based on pre-treatment CT evaluation were 88% for low pre-treatment risk profile patients (95% CI: 66-96%) and 34% (95% CI: 19-50%) for high pre-treatment risk profile patients (risk ratio 6.583; 95% CI: 2.265-9.129;p = 0.0001). Based on post-treatment CT, the local control rates at 2 years post-RT were 94% for score 1, 67% for score 2, and 10% for score 3 (risk ratio 4.760; 95% CI: 2.278-9.950 p = 0.0001). Post-RT CT scores added significant information to the pre-treatment risk profiles on prognosis. CONCLUSIONS: Pre-treatment CT risk profiles, as well as post-RT CT evaluation can identify patients, irradiated for laryngeal carcinomas, at high risk for developing local failure. When the post-RT CT score is available, it proves to be an even better prognosticator than the pre-treatment CT-risk profile.

Carcinoma, Squamous Cell↗
PubMed1998

Evaluation of pretreatment computed tomography as a predictor of local control in T1/T2 pyriform sinus carcinoma treated with definitive radiotherapy.

BACKGROUND: This study was undertaken to determine whether pretreatment computed tomography (CT) findings can predict local control in pyriform sinus carcinoma treated with definitive radiotherapy (RT). METHODS: Twenty-three patients with pyriform sinus carcinoma (T1: n = 5; T2: n = 18) were treated with high-dose RT and followed for a minimum of 2 years. Tumor volumes and extent were determined on pretreatment CT studies. The specific CT parameters assessed were analyzed as predictors of local control. RESULTS: There was a significant decrease in local control rate for tumors over 6.5 mL (1 of 4 [25%]) relative to tumors under 6.5 mL (17 of 19 [89%]; p = .021). Sensitivity and specificity for local control using this cutoff were 94% and 60%, respectively. Tumor score, as a measure of anatomic extent, was also found to be a significant predictor of local control (p = .033). The local control rate was not influenced significantly by the presence of "minimal" apex disease (< 10 mm in greatest dimensions as measured on CT) but decreased significantly when "bulk" apex disease (> OR = 10 mm) was present (p = .027). Laryngeal cartilage sclerosis was not a significant predictor of outcome. CONCLUSION: Computed tomography can stratify pyriform sinus carcinomas into groups more or less likely to be locally controlled with definitive RT.

Carcinoma, Squamous Cell↗
PubMed1998

Computed tomography for the detection of neck node metastases in melanoma patients.

AIMS: To assess the value of CT scanning for detection of lymph node metastases in the neck. METHODS: The appearance and site of the metastases was studied, as well as the sensitivity and specificity of CT. RESULTS: Nodal metastases did not always show a high contrast uptake and nodal density therefore cannot be used as a criterion for metastasis. Irregular contrast enhancement was seen in seven of the 21 tumour-positive necks. Frequently, metastases in the parotids, superficial nodes in the neck and in the posterior triangle were seen. The sensitivity and specificity of palpation and CT scanning were 87 and 100%, respectively. CONCLUSIONS: However, because small, clinically occult, melanoma metastases were frequently overlooked on CT, the role of this imaging modality in assessing occult metastases remains limited. Based on recent data from literature it is reasonable to speculate that ultrasound guided fine needle aspiration cytology (FNAC) will prove to be more effective than a non-invasive staging procedure of the neck in melanoma patients.

Adult↗
PubMed1998

Imaging of squamous cell carcinoma of the hypopharynx.

The hypopharynx is a clinically silent area and early lesions may be asymptomatic for a long period. At presentation, primary squamous cell carcinoma of this area is usually advanced. Almost all of these lesions are studied with imaging as part of the clinical work-up. The goal of this article is to help the practicing radiologist convey a report which provides information that will directly influence treatment of patients with hypopharyngeal carcinoma.

Carcinoma, Squamous Cell↗
PubMed1998

CT findings in chondroradionecrosis of the larynx.

PURPOSE: Our goal was to describe the CT findings before and after radiation therapy in a series of patients with laryngeal chondroradionecrosis. METHODS: The CT studies obtained before and after radiation therapy in nine patients with the diagnosis of laryngeal chondroradionecrosis were reviewed retrospectively. RESULTS: CT scans revealed abnormalities in all patients. A variable degree of laryngeal soft-tissue swelling was seen in eight of the patients. In four patients, cartilaginous abnormalities were visible initially, and appeared in three of four other patients who had further follow-up CT studies. Six patients had involvement of the thyroid cartilage; collapse of the thyroid cartilage was seen in two cases and gas bubbles were visible adjacent to the thyroid cartilage in three cases. Four patients with involvement of the thyroid cartilage eventually underwent total laryngectomy, and one died suddenly in severe respiratory distress. In all three patients with arytenoidal involvement, anterior dislocation of this cartilage was seen; in two of these patients, the adjacent part of the cricoid cartilage showed some sclerosis. Two patients with arytenoidal necrosis (both with cricoidal sclerosis) kept a functional larynx. In one case, cricoidal sclerosis was seen in association with lysis of the thyroid cartilage. CONCLUSION: The CT appearance of laryngeal chondroradionecrosis is nonspecific, but the diagnosis can be strongly suggested in cases of sloughing of the arytenoid cartilage, fragmentation and collapse of the thyroid cartilage, and/or in the presence of gas bubbles around the cartilage.

Adult↗
PubMed1997

The potential impact of CT-MRI matching on tumor volume delineation in advanced head and neck cancer.

PURPOSE: To study the potential impact of the combined use of CT and MRI scans on the Gross Tumor Volume (GTV) estimation and interobserver variation. METHODS AND MATERIALS: Four observers outlined the GTV in six patients with advanced head and neck cancer on CT, axial MRI, and coronal or sagittal MRI. The MRI scans were subsequently matched to the CT scan. The interobserver and interscan set variation were assessed in three dimensions. RESULTS: The mean CT derived volume was a factor of 1.3 larger than the mean axial MRI volume. The range in volumes was larger for the CT than for the axial MRI volumes in five of the six cases. The ratio of the scan set common (i.e., the volume common to all GTVs) and the scan set encompassing volume (i.e., the smallest volume encompassing all GTVs) was closer to one in MRI (0.3-0.6) than in CT (0.1-0.5). The rest volumes (i.e., the volume defined by one observer as GTV in one data set but not in the other data set) were never zero for CT vs. MRI nor for MRI vs. CT. In two cases the craniocaudal border was poorly recognized on the axial MRI but could be delineated with a good agreement between the observers in the coronal/sagittal MRI. CONCLUSIONS: MRI-derived GTVs are smaller and have less interobserver variation than CT-derived GTVs. CT and MRI are complementary in delineating the GTV. A coronal or sagittal MRI adds to a better GTV definition in the craniocaudal direction.

Adenocarcinoma↗
PubMed1997

Can pretreatment computed tomography predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy?

PURPOSE: To determine if pretreatment computed tomography (CT) can predict local control in T3 squamous cell carcinoma of the glottic larynx treated with definitive radiotherapy (RT). METHODS AND MATERIALS: Forty-two patients with previously untreated T3 squamous cell carcinoma of the glottic larynx were treated for cure with RT alone; all had a minimum 2-year follow-up. Tumor volumes and extent were determined by consensus of two head and neck radiologists on pretreatment CT studies. A tumor score was calculated and assigned to each primary lesion depending on the extent of laryngeal spread. Sclerosis of any laryngeal cartilage was recorded. The specific CT parameters assessed were correlated with local control. RESULTS: Tumor volume was a significant predictor of local control. For tumors measuring < 3.5 cm3, local control was achieved in 22 of 26 patients (85%), whereas for tumors > or = 3.5 cm3, local control was achieved in 4 of 16 patients (25%) (p = 0.0002). Sensitivity and specificity using this cutpoint were 85% and 75%, respectively. Tumor score as a measure of anatomic extent was also found to be a significant predictor of local control. The local control rate for tumors assigned a low tumor score (< or = 5) was 78% (21 of 27) compared to 33% (5 of 15) for tumors assigned a high tumor score (6, 7, or 8) (p = 0.008). A significant decrease in the local control rate was observed for cancers involving the paraglottic space at the false vocal cord level (14 of 16 [88%] vs. 12/26 [46%]) (p = 0.010), cancers involving the face of the arytenoid (15 of 18 [83%] vs. 11 of 24 [46%]) (p = 0.024), and tumors involving the interarytenoid region (25 of 36 [69%] vs. 1 of 6 [17%]; p = 0.020). There were 12 patients with sclerosis of both the ipsilateral arytenoid and the adjacent cricoid cartilage. These patients showed a significant decrease in local control (4 of 12 [33%]). CONCLUSION: Pretreatment CT can stratify patients with T3 glottic carcinoma into groups more or less likely to be locally controlled with definitive RT. The local control rate for these tumors can be improved using a CT-based tumor profile; the ideal CT profile for a radiocurable T3 glottic larynx carcinoma is volume < 3.5 cm3 and no or single laryngeal cartilage sclerosis.

Carcinoma, Squamous Cell↗
PubMed1997

Variability of tumor volumes in T3-staged head and neck tumors.

BACKGROUND: The Tumor Node Metastasis (TNM) classification system describes head and neck tumors using anatomic or unidimensional criteria and may therefore fail to define the actual three-dimensional tumor bulk. To investigate this we measured variability of tumor volumes (Vvol) in T3-staged head and neck tumors. METHODS: Patient material consisted of pretreatment computerized tomography (CT) scans of 71 patients, seen between 1990 and 1995, with T3 head and neck carcinoma involving different subsites. Computerized tomographic scans of 42 patients displayed distinct tumor boundaries and were free of motion and/or dental artifacts. Using these scans, tumor volumes were measured using the summation-of-areas technique, and Vvol was determined. RESULTS: Following are the tumor-volume measurements: T3 larynx carcinoma (n = 12) Vvol, 1.7-17.0 mL (median 3.7 mL); T3 oropharynx carcinoma (n = 13) Vvol, 10.0-41.2 mL (median 18.3 mL); T3 hypopharynx carcinoma (n = 10) Vvol, 8.9-67.8 mL (median 17.4 mL); T3 nasopharynx carcinoma (n = 3) Vvol, 3.7-30.1 mL; T3 maxillary sinus carcinoma (n = 4) Vvol, 56.0-103.1 mL. CONCLUSIONS: T3-Staged tumors of the head and neck show considerable variability of tumor volumes. Incorporation of tumor volume data may further refine the TNM staging system.

Adult↗
PubMed1997

Iodine-131 therapy in sporadic nontoxic goiter.

UNLABELLED: The effect of radioiodine in the treatment of nontoxic goiter is seldom evaluated quantitatively. The aim of this study was threefold: (a) to assess the effect of 131I on goiter volume, (b) to establish a relationship between CT volume reduction and the amount of radioactivity taken up by the thyroid and (b) to assess the precision of scintigraphic thyroid volume measurements. METHODS: In 27 patients with sporadic nontoxic goiter, the thyroid volume was estimated from a [99mTc]pertechnetate scintigram. Two different models (cylinder model and surface model) were applied. The 131I dosage varied between 507 and 3700 MBq. In all patients, noncontrast CT scanning of the neck was performed before therapy and 1 yr after therapy. RESULTS: The mean CT thyroid volume before therapy was 194 +/- 138 ml. A reduction was obtained in all patients and averaged 34% +/- 17%. The volume reduction measured by CT correlated well with the amount of 131I in the thyroid (r = 0.70). In thyroids larger than 200 ml, both scintigraphic volume estimation methods were imprecise. For smaller volumes, the surface model was superior. Hypothyroidism developed in 14% of the patients. No other side effects occurred. CONCLUSION: Iodine-131 therapy for volume reduction in nontoxic goiter is a safe and effective treatment. For scintigraphic estimation of thyroid gland volumes smaller than 200 ml, the surface model is preferred.

Adult↗
PubMed1996

Breast arterial calcifications: association with diabetes mellitus and cardiovascular mortality. Work in progress.

PURPOSE: To determine the relationship between breast arterial calcification, diabetes mellitus, and subsequent cardiovascular and noncardiovascular mortality. MATERIALS AND METHODS: A prospective cohort study was carried out in 12,239 women aged 50-68 years who participated in a breast cancer screening program. The screening mammograms were coded for the presence of breast arterial calcification. Diabetes (n = 442) was defined as use of insulin or oral hypoglycemic agents, use of a restricted diet for diabetes, or the presence of glucosuria. Data were available from questionnaires and urine glucose tests. Hazard ratios, which were adjusted for age, smoking, parity, and obesity, were calculated from mortality data after 16-19 years of follow-up. RESULTS: Breast arterial calcification was seen in 9.0% (1,107 of 12,239) of all women and in 15.4% (68 of 442) of the diabetic women. An excess cardiovascular mortality of 40% (hazard ratio = 1.4; 95% confidence interval = 1.1, 1.8) was found for all women with breast arterial calcification. In diabetic women, the presence of breast arterial calcification was associated with a 90% (hazard ratio = 1.9; 95% confidence interval = 1.1, 3.2) increase in cardiovascular mortality. CONCLUSION: Breast arterial calcification represents an independent risk factor for cardiovascular mortality in women over 50 years of age, especially in those with diabetes.

Aged↗